Determination of inmune response and inflammation mediators in tears: Changes in dry eye and glaucoma as compared to healthy controls. / Determinación de mediadores de la respuesta inmune e inflamación en lágrimas: cambios en ojo seco y glaucoma frente a población sana.

OBJECTIVE: To determine the expression profile of immune response and inflammation (IRI) mediator molecules in tears from patients with dry eye (DE), and those suspected of having or have primary open-angle glaucoma (POAG) under treatment and compare them with healthy controls. METHODS: A prospective observational cohort study including 107 participants sub-divided into: healthy controls (CG; n=30), patients with DE (DEG; n=41) and patients suspected of having or have POAG and on hypotensive treatment (POAG-G; n=36). Tear samples were collected by capillary to be processed using a multi-immunoassay system based on flow cytometry (Luminex R-200 ®), in order to determine the interleukins (IL): 1ß, 2, 4, 5, 6, and 10, and the growth factors: Tumour necrosis alpha (TNF-α), vascular endothelial (VEGF), and granulocyte-macrophage colony stimulating- (GM-CSF). Data were processed using the SPSS 20.0 program. RESULTS: Molecules that significantly increased in tears from DEG vs. POAG-G patients were: IL-1 (P=.01), IL-6 (P=.004), IL-10 (P=.04), whereas VEGF significantly decreased in the DEG. The POAG-G showed significantly higher IL-6 values (P<.0001) as compared to the CG. When comparing both the DEG and POAG-G, significant differences were observed in tear expression of IL-4 (P=.004), IL-6 (P=.002), TNF-α (P=.03), GM-CSF (P=.03), and VEGF (P=.002). CONCLUSIONS: The increased expression of IRI mediators in tears from patients with DE or POAG strongly demonstrated the importance of immune response in both pathologies. However, the different molecules involved also suggest distinct signalling pathways for these processes that still require further research.

[Efficacy of lisdexamphetamine to improve the behavioural and cognitive symptoms of attention deficit hyperactivity disorder: treatment monitored by means of the AULA Nesplora virtual reality test]. / Eficacia de la lisdexanfetamina en la mejora sintomatica conductual y cognitiva del trastorno por deficit de atencion/ hiperactividad: tratamiento monitorizado mediante el test AULA Nesplora de realidad virtual.

INTRODUCTION: Lisdexanfetamine (LDX) is the drug for attention deficit hyperactivity disorder (ADHD) undergoing the largest research volume in the latest years. However, no studies certify its usefulness for the improvement of cognitive functioning in ADHD. AIM: To evaluate the efficacy of LDX in the behavioral and cognitive improvement of a group of patients with ADHD. Such efficacy was measured by means of the administration of AULA Nesplora virtual reality test before the prescription of pharmacological treatment and right after the treatment with LDX. PATIENTS AND METHODS: The sample comprised 85 patients between 6 and 16 years, with clinical diagnosis of ADHD, who attended treatment in a neuropediatrics consultation. All patients started pharmacological treatment with the proper dose of LDX after the clinical interview and the first administration of AULA test. After an average treatment of 7.5 months, AULA was administered again and the treatment progress based on cognitive and motor symptomatology was assessed. RESULTS: Results showed highly significant improvements in selective and sustained attention, quality of attention focus and hyperactivity; moderate improvements in impulsivity; and an incidence close to zero in processing speed. CONCLUSIONS: LDX constitutes an adequate treatment for the substantial improvement of attention and hyperactivity; such improvement can be monitored accurately by means of AULA virtual reality test.

TITLE: Eficacia de la lisdexanfetamina en la mejora sintomatica conductual y cognitiva del trastorno por deficit de atencion/ hiperactividad: tratamiento monitorizado mediante el test AULA Nesplora de realidad virtual.Introduccion. La lisdexanfetamina (LDX) es el farmaco para el trastorno por deficit de atencion/hiperactividad (TDAH) con mayor volumen de investigacion de los ultimos años. No obstante, no hay estudios que certifiquen su utilidad para la mejoria del funcionamiento cognitivo en el TDAH. Objetivo. Evaluar la eficacia de la LDX en la mejora sintomatica conductual y cognitiva en un grupo de pacientes con TDAH. Dicha eficacia fue medida mediante la administracion del test AULA Nesplora de realidad virtual antes de la prescripcion del tratamiento farmacologico y despues del tratamiento con LDX. Pacientes y metodos. La muestra estaba compuesta por 85 pacientes de 6-16 años, con diagnostico clinico de TDAH y que asistian a tratamiento en una consulta de neuropediatria. Todos los pacientes iniciaron el tratamiento farmacologico con la correspondiente dosis de LDX tras la entrevista clinica y la primera administracion del test AULA. Tras un tratamiento medio de 7,5 meses, se les administro AULA nuevamente y se valoro el progreso del tratamiento farmacologico sobre la sintomatologia cognitiva y motora. Resultados. Se apreciaron mejorias muy significativas en la atencion selectiva y sostenida, la calidad del foco atencional y la hiperactividad, mejorias moderadas en la impulsividad, y una incidencia casi nula en la velocidad de procesamiento. Conclusiones. La LDX constituye un tratamiento adecuado para la mejora sustancial de la atencion e hiperactividad, y dicha mejora puede monitorizarse de forma precisa mediante el test de realidad virtual AULA.

[Brimonidine intoxication in paediatrics. A presentation as intracranial hypertension syndrome]. / Intoxicación por brimonidina en pediatría. Presentación como síndrome de hipertensión intracraneal.

BACKGROUND: Brimonidine is an extremely lipophilic drug which is absorbed very well through the cornea and thus crosses the blood-brain barrier. This is very important for any potential toxic effects on the CNS. OBJECTIVES: To show the adverse effects of brimonidine and advise the need for caution in its use in the paediatric population. CONCLUSIONS: Brimonidine is prohibited from use in toddlers and infants. Its adverse effects can be severe or lethal. It should be suspected in treated patients with compatible symptoms in whom organic disease has been ruled out. We must stop the use of brimonidine and adopt support measures.

Intoxicación por brimonidina en pediatría. Presentación como síndrome de hipertensión intracraneal / Brimonidine intoxication in paediatrics. A presentation as intracranial hypertension syndrome

Antecedentes: La brimonidina es un fármaco muy lipofílico absorbido muy bien por vía transcorneal, que atraviesa la barrera hematoencefálica, con el potencial efecto tóxico para el sistema nervioso central que esto supone. Objetivos: Dar a conocer los efectos secundarios de la brimonidina tópica y remarcar la necesidad de precaución con fármacos tópicos en pediatría. Conclusiones: La brimonidina se desaconseja en niños pequeños y lactantes. Sus efectos secundarios sistémicos pueden ser graves o incluso letales. Debemos sospecharlo en pacientes tratados con síntomas compatibles en los que se descarta patología orgánica. Debemos actuar suspendiendo el fármaco y adoptando las medidas de soporte necesarias

Background: Brimonidine is an extremely lipophilic drug which is absorbed very well through the cornea and thus crosses the blood-brain barrier. This is very important for any potential toxic effects on the CNS. Objectives: To show the adverse effects of brimonidine and advise the need for caution in its use in the paediatric population. Conclusions: Brimonidine is prohibited from use in toddlers and infants. Its adverse effects can be severe or lethal. It should be suspected in treated patients with compatible symptoms in whom organic disease has been ruled out. We must stop the use of brimonidine and adopt support measures